Regional Interdependence in Low Back Pain: Interventions: Difference between revisions
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=== Hip<ref name="Whitman 1">Whitman JM, Flynn TW, Fritz, JM. Nonsurgical management of patients with lumbar spinal stenosis: a literature review and a case series of three patients managed with physical therapy. Phys Med Rehabil Clin N Am 2003;14:77-101. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/12622484 (accessed 29 Oct 2013).</ref><ref name="Whitman 2">Whitman JM, Flynn TW, Childs JD, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine 2006;31(22):2541-2549. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/17047542 (accessed 29 Oct 2013).</ref><ref name="Cibulka">Cibulka MT. Low Back Pain and its Relation to the Hip and Foot. J Orthop Sports Phys Ther 1999;29(10):595-601. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/10560068 (accessed 26 Oct 2013)</ref><ref name="Lejkowski">Lejkowski PM, Poulsen E. Elimination of intermittent chronic low back pain in a recreational golfer following improvement of hip range of motion impairments. Journal of Bodywork &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Movement Therapies 2013;17:448-452. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/24139002 (accessed 29 Oct 2013).</ref><ref name="Burns">Burns SA, Mintken PE, Austin GP, Cleland J. Short-term response of hip mobilizations and exercise in individuals with chronic low back pain: a case series. Journal of Manual and Manipulative Therapy 2011;19(2):100-107. Pub Med Link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172945/ (accessed 29 Oct 2013).</ref> === | === Hip<ref name="Whitman 1">Whitman JM, Flynn TW, Fritz, JM. Nonsurgical management of patients with lumbar spinal stenosis: a literature review and a case series of three patients managed with physical therapy. Phys Med Rehabil Clin N Am 2003;14:77-101. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/12622484 (accessed 29 Oct 2013).</ref><ref name="Whitman 2">Whitman JM, Flynn TW, Childs JD, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine 2006;31(22):2541-2549. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/17047542 (accessed 29 Oct 2013).</ref><ref name="Cibulka">Cibulka MT. Low Back Pain and its Relation to the Hip and Foot. J Orthop Sports Phys Ther 1999;29(10):595-601. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/10560068 (accessed 26 Oct 2013)</ref><ref name="Lejkowski">Lejkowski PM, Poulsen E. Elimination of intermittent chronic low back pain in a recreational golfer following improvement of hip range of motion impairments. Journal of Bodywork &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Movement Therapies 2013;17:448-452. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/24139002 (accessed 29 Oct 2013).</ref><ref name="Burns">Burns SA, Mintken PE, Austin GP, Cleland J. Short-term response of hip mobilizations and exercise in individuals with chronic low back pain: a case series. Journal of Manual and Manipulative Therapy 2011;19(2):100-107. Pub Med Link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172945/ (accessed 29 Oct 2013).</ref> === | ||
Manipulation<br> | Manipulation<br> | ||
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<br> | <br> | ||
*Hip Posterior to Anterior Mobilization with Flexion, Abduction, and External Rotation | *Hip Posterior to Anterior Mobilization with Flexion, Abduction, and External Rotation<ref name="Burns" /> | ||
[[Image:Hip PA with flex, abd, ER.JPG|300px]]<br> | [[Image:Hip PA with flex, abd, ER.JPG|300px]]<br> | ||
*Hip Anterior to Posterior Mobilization with Flexion, Adduction, and Internal Rotation | *Hip Anterior to Posterior Mobilization with Flexion, Adduction, and Internal Rotation<ref name="Burns" /> | ||
[[Image:Hip AP with flex add IR.JPG|300px]]<br> | [[Image:Hip AP with flex add IR.JPG|300px]]<br> | ||
| Line 64: | Line 64: | ||
* Strengthening | * Strengthening | ||
- Hip Abduction with slight extension and internal rotation | - Hip Abduction with slight extension and internal rotation<ref name="Cibulka" /> | ||
[[Image:Hip Abduction with IR.JPG|300px]] | [[Image:Hip Abduction with IR.JPG|300px]] | ||
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* Flexibility<br> | * Flexibility<br> | ||
- Supine Iliopsoas Stretch | - Supine Iliopsoas Stretch<ref name="Whitman 1" /><ref name="Whitman 2" /> | ||
[[Image:Supine Iliopsoas Stretch.JPG|300px]] | [[Image:Supine Iliopsoas Stretch.JPG|300px]] | ||
- Prone Rectus Femoris Stretch | - Prone Rectus Femoris Stretch<ref name="Whitman 1" /><ref name="Whitman 2" /> | ||
[[Image:Prone Rectus Femoris Stretch.JPG|300px]] | [[Image:Prone Rectus Femoris Stretch.JPG|300px]] | ||
Revision as of 23:56, 14 November 2013
Original Editors - Brandan Lym, Mitchell Blythe, Cory Horstman, Nathan Domino, and Dana Schmidt part of the Des Moines University Student Project
REGIONAL INTERDEPENDENCE[edit | edit source]
- Regional interdependence is the concept that a musculoskeletal treatment targeting a specific area of the body could have effects in another, seemingly unrelated, part of the body[1].
- There is a growing body of evidence to support the treatment of Low Back Pain through interventions aimed at the thoracic spine and the hip joints.
EXAMINATION [edit | edit source]
- When treating patients with Low Back Pain be sure to perform Lumbar Examination as well as Hip Examination and Thoracic Examination. This will provide a thorough information on which to base your choice of interventions and ensure safety during those interventions.
INTERVENTIONS[edit | edit source]
- Interventions directed at the Thoracic Spine and the Hip Joints have show to be beneficial for patients suffering from low back pain.
Thoracic Spine[2][edit | edit source]
Manipulation
- Supine Thoracic Posterior to Anterior HVLA Manipulation
Hip[3][4][5][6][7][edit | edit source]
Manipulation
- Supine Long Axis Distraction Thrust Manipulation[7]
- Hip Posterior to Anterior Mobilization with Flexion, Abduction, and External Rotation[7]
- Hip Anterior to Posterior Mobilization with Flexion, Adduction, and Internal Rotation[7]
Therapeutic Exercise
- Strengthening
- Hip Abduction with slight extension and internal rotation[5]
- Flexibility
- Supine Iliopsoas Stretch[3][4]
- Prone Rectus Femoris Stretch[3][4]
Outcomes[edit | edit source]
| Articles | Body Region Treated | Techniques Utilized | Level of Evidence | Improved Oswestry Disability Index Score | Improved Fear Avoidance Behavioral Questionairre Score | Improved Global Rating of Change Score | Improved Modified Spinal Stenosis Scale Score | Improved Pain Pressure Threshold | Decreased Pain | Improved Function |
| Burns et al. | Hip | 4 | X | X | X | X | ||||
| Cibulka | Hip | 4 | X | X | X | |||||
| Oliviera et al. | Thoracic Spine | 2 | X | X | ||||||
| Whitman et al. 2003 | Hip | 4 | X | X | X | X | ||||
| Whitman et al. 2006 | Hip | 2 | X | X | X | X | X | |||
| Lejkowski & Poulsen | Hip | 4 | X | X |
- An "X" denotes improvement in each specific category regardless of statistical significance.
Clinical Implications
[edit | edit source]
- Utilizing manual therapy interventions targeted at the hip and thoracic spine along with therapeutic exercise has been shown to provide improved outcomes for patients with low back pain. Clinicians should consider these interventions along with treatments focused on the low back to treat the entire patient and achieve improved results. Additional information can be found in the references listed below.
References[edit | edit source]
- ↑ Wainner RS, Whitman JM, Cleland JA, Flynn TW. Regional Interdependence: A Musculoskeletal Examination Model Whose Time Has Come. J Orthop Sports Phys Ther 2007;37(11):658-660. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/18057674 (accessed 26 Oct 2013).
- ↑ Oliveira RF, Liebano RE, Costa LCM, Rissato LL, Costa LOP. Immediate Effects of Region-Specific and Non-Region-Specific Spinal Manipulative Therapy in Patients With Chronic Low Back Pain: A Randomized Controlled Trial. Phys Ther 2013;93(6):748-756. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/23431209 (accessed 28 Oct 2013).
- ↑ 3.0 3.1 3.2 3.3 3.4 Whitman JM, Flynn TW, Fritz, JM. Nonsurgical management of patients with lumbar spinal stenosis: a literature review and a case series of three patients managed with physical therapy. Phys Med Rehabil Clin N Am 2003;14:77-101. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/12622484 (accessed 29 Oct 2013).
- ↑ 4.0 4.1 4.2 4.3 4.4 Whitman JM, Flynn TW, Childs JD, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine 2006;31(22):2541-2549. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/17047542 (accessed 29 Oct 2013).
- ↑ 5.0 5.1 Cibulka MT. Low Back Pain and its Relation to the Hip and Foot. J Orthop Sports Phys Ther 1999;29(10):595-601. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/10560068 (accessed 26 Oct 2013)
- ↑ 6.0 6.1 6.2 Lejkowski PM, Poulsen E. Elimination of intermittent chronic low back pain in a recreational golfer following improvement of hip range of motion impairments. Journal of Bodywork &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Movement Therapies 2013;17:448-452. Pub Med Link: http://www.ncbi.nlm.nih.gov/pubmed/24139002 (accessed 29 Oct 2013).
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Burns SA, Mintken PE, Austin GP, Cleland J. Short-term response of hip mobilizations and exercise in individuals with chronic low back pain: a case series. Journal of Manual and Manipulative Therapy 2011;19(2):100-107. Pub Med Link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172945/ (accessed 29 Oct 2013).
